Infected total knee arthroplasty. Basic science, management and outcome

Abstract

Numbers of primary elective total knee arthroplasties (TKAs) are steadily increasing and so is the number of revisions. The most common complications after primary TKA are pneumonia, pulmonary embolism and wound or periprosthetic joint infection [1] (Fig. 22.1). Surgical site infection (SSI) is one of the most serious complications of TKA and may be the most common cause of early failure and revision [2, 3]. In Britain, it is estimated that 25 % of TKA revisions are due to infection [4]. The rate of periprosthetic infection varies across different studies. An average rate of 1 % is reported, although there are studies which present higher rates in primary (0.5-2 %) and revision surgery (2-5 %) [3]. Lower rates (0.31 %) are also reported from specialized centers with ultraclean operating theatres [5-7]. Infection after TKA leads to an increased risk of patient morbidity and mortality and to a higher cost for treatment. It is estimated that the annual cost of periprosthetic joint infection revisions exceeds $566 million in the United States and is growing [8]. The average cost of in hospital care is estimated to be double in SSI compared to non SSI patients [5]. The higher cost is related to extended hospital stays, frequent readmissions, prolonged use of antibiotics and higher postoperative rehabilitation periods.